Provider Demographics
NPI:1427155902
Name:MILLER, CLIFFORD FARMER (LCSW)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:FARMER
Last Name:MILLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 TUSCULUM BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37745-3949
Mailing Address - Country:US
Mailing Address - Phone:423-278-8805
Mailing Address - Fax:423-370-1494
Practice Address - Street 1:312 TUSCULUM BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-3949
Practice Address - Country:US
Practice Address - Phone:423-278-8805
Practice Address - Fax:423-370-1494
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-19
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000010921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3694507Medicaid
TN3923920Medicaid
TN3923929Medicare ID - Type UnspecifiedPROVIDER NUMBER